Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis and Care Cascade for HIV-infected Individuals (SAIA-HTN)

优化 HIV 感染者高血压诊断和护理级联的系统分析和改进方法 (SAIA-HTN)

• 批准号: 10153876
• 负责人: Sarah Odell Gimbel
• 金额: $ 66.86万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10153876
• 关键词: Accountability; Address; Adherence; Adoption; Adult; Affect; Africa South of the Sahara; Antihypertensive Agents; Area; Awareness; Blood Pressure; Blood Pressure Monitors; Cardiovascular Diseases; Caring; Cessation of life; Chronic Care; Clinical; Cluster randomized trial; Communication; Complex; Consensus; Consolidated Framework for Implementation Research; Cost Effectiveness Analysis; Cost Measures; Country; Data; Decision Making; Detection; Diagnosis; Effectiveness; Environment; Evidence based intervention; Facility Controls; Failure; Focus Groups; Foundations; Goals; Guidelines; HIV; Health; Health Personnel; Heterogeneity; Hypertension; Individual; Intervention; Interview; Laboratories; Link; Mainstreaming; Measures; Modeling; Modification; Mother-to-child HIV transmission; Motivation; Mozambique; Outcome; Output; Patient Care; Patient-Focused Outcomes; Patients; Performance; Pharmaceutical Preparations; Pharmacy facility; Policies; Population; Prevalence; Prevention; Qualitative Evaluations; Readiness; Reporting; Resources; Services; Standardization; System; Systems Analysis; Testing; Viral; antiretroviral therapy; care systems; cost; cost effectiveness; cost utility analysis; design; disability-adjusted life years; effective intervention; effectiveness evaluation; evidence base; flexibility; hypertension control; implementation fidelity; implementation intervention; implementation process; improved; informant; innovation; intervention cost; low and middle-income countries; low income country; novel; organizational readiness; outpatient programs; population health; prospective; randomized controlled design; scale up; screening; service delivery; success; system-level barriers; systematic review; therapy design; tool

Undiagnosed and untreated hypertension (HTN) is one of the largest drivers of cardiovascular disease (CVD) in sub-Saharan Africa (sSA). Across sSA, evidence-based, clinical guidelines to screen and manage hypertension exist; however, country level application is low and uneven due to lack of service readiness, uneven health worker motivation, lack of accountability for health worker performance and poor integration of HTN screening and management with chronic care services. In Mozambique – like many countries with high HIV burden – the HIV treatment platform was the first broadly implemented chronic care service. With large numbers of patients on anti-retroviral treatment (850,000 in Mozambique), it presents a unique opportunity to standardize and scale hypertension screening and management. Low-cost, systems level interventions are effective and efficient approaches to improve linked cascade services, and may be effective for routinizing HTN diagnosis and management within existing chronic care services; addressing both individual and systems-level barriers; improving flow through the HTN cascade; and ultimately improving patient level outcomes. The Systems Analysis and Improvement Approach (SAIA) is designed to optimize cascade performance, is feasible for frontline healthcare workers and managers, and is applicable to optimize the HTN testing and treatment cascade for people living with HIV (PLHIV) across multiple contexts. We have successfully piloted SAIA for the HTN cascade for PLHIV, and as HTN screening and management is mainstreamed into chronic care services in sSA (including in Mozambique), demonstrating SAIA-HTN potential effectiveness as an adaptable, scalable model for broad implementation. The overall goal of SAIA-HTN is to evaluate a model for systematic assessment and improvement of HTN diagnosis and management services for PLHIV in Mozambique. Our specific aims are to: (1) Determine the effectiveness of SAIA-HTN on HTN cascade optimization for HIV-infected individuals; (2) Determine the drivers of SAIA-HTN intervention implementation heterogeneity across facilities; (3) Determine the costs and cost-effectiveness of SAIA-HTN for care cascade optimization. We will deploy a cluster randomized trial to evaluate the impact of the SAIA-HTN intervention on hypertension management in 8 intervention and 8 control facilities. Effectiveness will be measured via HTN cascade flow measures for PLHIV and HTN and HIV clinical outcomes. Intervention costs will be assessed from the payer perspective (e.g. MOH), and cost effectiveness analysis conducted to estimate the incremental costs for additional patients passing through the HTN cascade steps, and the cost per additional disability-adjusted life year averted (DALY). The implementation process will be described using focus group discussions and key informant interviews analyzed using the Consolidated Framework for Implementation Research, with complementary data from study logs to describe fidelity to the SAIA-HTN intervention design.

未诊断和未经治疗的高血压（HTN）是心血管疾病的最大驱动因素之一 （CVD）在撒哈拉以南非洲（SSA）。跨SSA，基于证据的临床指南，以筛选和管理 存在高血压；但是，由于缺乏服务准备，国家一级的应用较低且不平衡， 卫生工作者的动力不平，对卫生工作者表现缺乏责任和整合不良 通过长期护理服务进行HTN筛查和管理。在莫桑比克 - 像许多国家一样 Hiv HIV Burnen - HIV治疗平台是第一个广泛实施的慢性护理服务。和 大量的抗逆转录病毒治疗患者（莫桑比克850,000例），它提出了独特的 标准化和扩展高血压筛查和管理的机会。低成本，系统级别 干预措施是改善链接级联服务的有效和有效的方法，可能是 有效地将HTN诊断和管理在现有的慢性护理服务中有效； 解决个人和系统级别的障碍；改善通过HTN级联的流动；和 最终改善患者水平的结果。 系统分析和改进方法（SAIA）旨在优化级联绩效， 对于一线医疗人员和经理来说是可行的，适用于优化HTN测试和 在多种情况下为艾滋病毒（PLHIV）患者（PLHIV）患者进行治疗级联。我们已经成功驾驶 SAIA用于PLHIV的HTN级联 SSA的护理服务（包括莫桑比克），证明了Saia-HTN潜在有效性 适应性的，可扩展的模型，用于广泛实施。 SAIA-HTN的总体目标是评估模型 用于系统评估和改进HTN诊断和管理服务的PLHIV 莫桑比克。我们的具体目的是：（1）确定SAIA-HTN对HTN级联的有效性 针对感染HIV的个体的优化； （2）确定SAIA-HTN干预实施的驱动因素 跨设施的异质性； （3）确定SAIA-HTN护理级联的成本和成本效益 优化。我们将部署一项群集随机试验，以评估SAIA-HTN干预的影响 关于8个干预和8个控制设施的高血压管理。有效性将通过 PLHIV和HTN和HIV临床结果的HTN级联流量测量。干预费用将是 从付款人的角度（例如MOH）进行评估，并进行了成本效益分析以估算 通过HTN级联步骤的其他患者的增量成本，每额外的成本 避免了残疾调整的生命年（Daly）。实施过程将使用焦点小组描述 使用合并框架分析的讨论和关键的线人访谈进行实施 研究，通过研究日志的完整数据来描述SAIA-HTN干预设计的保真度。